Parity in mental-health care lags, critics say

Sunday

When state and federal lawmakers created separate mental-health parity laws, advocates were thrilled that people with mental-health issues would be able to get coverage for the care they need.

When state and federal lawmakers created separate mental-health parity laws, advocates were thrilled that people with mental-health issues would be able to get coverage for the care they need.

But five years after the state law was enacted and almost two years into the federal law, some of that enthusiasm has waned.

Advocates say they don’t see the parity that was promised, and in some cases, people are being denied coverage while others are discharged too soon from psychiatric hospitals.

Limits are the problem: too few sessions with mental-health experts, and not enough days in inpatient psychiatric units.

“The problem is, it takes a while for the brain to recover from the illness that affects it, and health coverage just doesn’t meet the need,” said Terry Russell, executive director of the National Alliance on Mental Illness of Ohio.

He said the length of a patient’s stay in a hospital or the number of sessions with a mental-heath professional should be decided by a doctor, not by an insurance company.

“We would want it to be on an individual basis, and it would be a physician’s choice,” Russell said. “We understand health-care costs have to have some limits, but we want doctor’s expertise for a person who’s severely ill.”

Ohio’s mental-health-parity law requires that patients with physical illnesses and those with specific biological mental illnesses have access to the same number of physician visits as well as the same co-payments and deductibles. Those specific illnesses are schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder and paranoia.

Federal law requires that health insurers and employer health plans that are self-insured with 50 or more workers set co-payments, deductibles and treatment limits for mental illnesses the same way they do for medical and surgical benefits.

“If there is no limit for physician visits, then that’s the same for behavioral health,” said Dr. Rhonda Robinson Beale, chief medical officer of OptumHealth Behavioral Solutions, a California-based health-management company owned by UnitedHealth Group.

“It’s not logical for an employer to cut out behavioral health, because it’s going to come back and bite them” in absenteeism and employee performance problems at work, she said.

“If there is no limit for physician visits, then there are no limits for behavioral-health visits. That’s what parity requires.”

However, mental-health advocates say that’s not what they’re seeing when trying to help patients and their families.

“It appears that there’s an unwritten limit of services that people receive,” Russell said. “We see too many people being released from an inpatient unit too quickly.”

Despite what advocates say, business leaders say employers aren’t shirking their responsibility or violating either law.

“I don’t see any way they can say businesses aren’t complying with the parity law,” said Linda Woggon, executive vice president at the Ohio Chamber of Commerce.

“If a business is purchasing an insurance policy, the policy has to provide coverage for both medical and mental health. That’s the law; there’s no way they can get around that.”

She said there are limitations to physical sides of many insurance policies, which means there would be mental-health limits, too. For example, women can have one mammogram every year after age 40, not one every nine months. And if you get only 10 counseling sessions a year, you may get only 10 physician visits.

“You may not see what the physical side of that policy is,” Woggon said. “Sometimes, people think parity is, ‘You can have whatever you want,’ instead of, ‘It has to be equal with the physical treatment.’??”

Advocates say that if that’s true, then why are people whose biological mental illnesses have been diagnosed being denied coverage?

“What we continue to hear daily is that people, even though they may qualify with one of the major illnesses, are getting turned down (for treatment) because they’re being told that it wasn’t medically necessary,” said Betsy Johnson, associate executive director with NAMI of Ohio.

“They’re waiting in hospital emergency rooms to be turned down by private insurance.”

Some local hospitals can have as many as 10 patients linger for days in emergency departments because there aren’t enough inpatient beds at private and state hospitals to treat psychiatric patients.

Health insurers say that medical necessity isn’t something that a company determines, and that it’s not arbitrarily applied to customers case by case.

“Most carriers, when they’re reviewing medical necessity, they follow federal guidelines that are very well-established in the health-care arena,” said Paula Sauer, senior vice president of pharmacy and care management at Medical Mutual of Ohio.

Even though insurers and employer groups say they’re doing what’s required of them, advocates say that when it gets to the mental-health-patient level, nothing has changed since the law was enacted in 2006.

“When we got the health-care parity passed, we thought there would be a significant change, and that has not happened,” Russell said.

Mental illness “should be treated like any other illness, that’s all. No different and no less, but right now, it is less.”

shoholik@dispatch.com

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